Anorectal dynamics in low rectal carcinoma patients undergoing intersphincteric resection

Abstract

Objective To investigate the changes of anorectal dynamics in low rectal carcinomapatients subject to three different kinds of treatments undergoing intersphincteric resection (ISR),evaluatethe clinical effects on anorectal dynamics by three different kinds of treatments,and to discuss the mecha-nisms.Methods 113 low rectal carcinoma patients who received ISR were divided ioto three groups:neo-adjuvant chemotherapy with laparoscopic anterior resection ISR group (group A,n =32),laparoscopic an-terior resection ISR group (group B,n =43 ),open anterior resection ISR group ( group C,n =38 ).Theanorectal dynamics in the three groups was determined and compared before and 3,6,9,12 months afteroperation by an anorectal pressure detector.Results The level of anal resting pressure in the three groupsat 3rd month after operation [(33.53 ± 6.58),(24.69 ± 5.62),( 14.86 ± 5.54) mm Hg ( 1 mm Hg =0.133 kPa)] were remarkably lower than those before operation [(49.37 ± 14.32),(47.32 ± 7.87),(46.50±10.02) mmHg (P＜0.05)],but hada nilder decrease in group A (33.53±6.58) mmHgthan in group B (24.69 ± 5.62) mm Hg and group C (14.86 ± 5.54 )mm Hg ( P ＜ 0.05 ).The positiverate of rectoanal inhibitory reflex at 3rd month after operation was lower significantly than that before opera-tion ( P ＜ 0.05 ),but that in group A was higher than in group B and group C (P ＜ 0.05 ).As comparedwith group B,the levels of balloon-discharge test time,initial defecation capacity threshold and maximumtolerated volume in group A almost recovered to those before operation 3 months ahead of time ( P ＜ 0.05),and as compared with group C,6 months in advance recovery to preoperative levels (P ＜0.05).Conclu-sion Neoadjuvant chemotherapy with laparoscopic anterior resection is appropriate even more for low rectalcarcinoma ISR patients. Key words: Rectal neoplasms; Intersphincteric resection; Anorectal dynamics